CHRONIC DISEASESNovember 18, 2010

CHRONIC DISEASES 7 out of 10 deaths among Americans

each year are from chronic diseases.

Heart disease, cancer and stroke account for more than 50% of all deaths each year.

In 2005, 133 million Americans – almost 1 out of every 2 adults – had at least one chronic illness.

CHRONIC DISEASES Four Common Causes of Chronic Disease

Smoking 43 million Americans smoke

Physical Activity More than one-third of all adults do not meet

recommendations for aerobic physical activity Nutrition

In 2007, less than 22% of high school students9 and only 24% of adults reported eating 5 or more servings of fruits and vegetables per day.

Alcohol alcohol is a risk factor for primary liver cancer, and more

than 100 studies have found an increased risk of breast cancer with increasing alcohol intake. The link between alcohol consumption and colorectal (colon) cancer has been reported in more than 50 studies

CARDIOVASCULAR DISEASE: AN EPIDEMIOLOGICAL OVERVIEW

Cardiovascular Disease (CVD)Cardiovascular disease is the cause of 37 percent of

all deaths in the United States.For all ages combined, CVD is the leading cause of

death.More than 80 million Americans—1 out of every 3

adults—will have some type of CVD.The best defense against CVD is to prevent it from

developing in the first place.

Do you know someone who has had a heart problem?

PREVALENCE OF CARDIOVASCULAR DISEASES (CVDS) IN ADULTS AGED 20 AND OLDER BY AGE AND SEX

UNDERSTANDING THE CARDIOVASCULAR SYSTEM

The Heart: A Mighty MachineFour chambers

Two upper chambers are called atria Two lower chambers are called ventricles

Valves regulate the flow of blood.

BLOOD FLOW WITHIN THE HEART

UNDERSTANDING THE CARDIOVASCULAR SYSTEM

Heart FunctionDeoxygenated blood enters the right atriumFrom the right atrium, blood travels to the right

ventricleBlood is pumped through the pulmonary artery to

the lungs, where it receives oxygenOxygenated blood from the lungs returns to the left

atrium of heartBlood from the left atrium moves into the left

ventricleThe left ventricle pumps blood through the aorta to

all body parts

PERCENTAGE BREAKDOWN OF DEATHS FROM CARDIOVASCULAR DISEASE IN THE UNITED STATES

CARDIOVASCULAR DISEASE

Atherosclerosis (CAD— coronary artery disease)ArteriosclerosisHyperlipidemia Inflammatory riskPeripheral artery disease (PAD)

Coronary Heart Disease (CHD)Greatest killerMyocardial infarction (MI) or heart attack

ATHEROSCLEROSIS AND CORONARY HEART DISEASE

CARDIOVASCULAR DISEASE Angina Pectoris

Ischemia—condition that reduces the heart’s blood and oxygen supply

People with ischemia often suffer angina pectoris, or chest pain and pressure.

Treatments include calcium channel blockers or beta-blockers

Arrhythmias Irregularity in heart rhythmFibrillationOver 4 million Americans have experienced some

type of arrhythmia

CARDIOVASCULAR DISEASE

Congestive Heart Failure (CHF)Affects over 5 million AmericansSingle most frequent cause of hospitalization in United

States Stroke

6.5 million Americans suffer strokes every yearBlood supply to brain is interruptedTransient ischemic attacks (TIAs) are brief

interruptions of the blood supply to the brain that cause temporary impairment.

Today, stroke is a leading cause of serious long-term disability and contributes a significant amount to Medicaid and Medicare expenses for older Americans, particularly women.

REDUCING YOUR RISKS

Metabolic Syndrome: Quick Risk ProfileFor a diagnosis of metabolic syndrome, a person

would have three or more of the following risks: Abdominal obesity Elevated blood fat (triglycerides greater than 150 units) Low levels of HDL (“good”) cholesterol Elevated blood pressure greater than 130/85 mm/Hg Elevated fasting glucose greater than 100 mg/dL High levels of C-reactive proteins

REDUCING YOUR RISKS Modifiable Risks

Avoid tobacco.Cut back on saturated fats and cholesterol.

Low-density lipoproteins (LDL) High-density lipoproteins (HDL) Triglycerides

Maintain a healthy weight.Exercise regularly.Control diabetes.Control blood pressure.Manage stress.

RECOMMENDED CHOLESTEROL LEVELS FOR ADULTS

BLOOD PRESSURE CLASSIFICATIONS

REDUCING YOUR RISKS

Non-modifiable RisksRace and ethnicityHeredityAgeGender

Other Risk Factors Being Studied Inflammation and C-reactive proteinHomocysteine

WEAPONS AGAINST CARDIOVASCULAR DISEASE

Bypass Surgery and AngioplastyCoronary bypass surgery helps patients who suffer

from coronary blockages of heart attacks. In bypass surgery, a blood vessel is taken from

another site in the patient’s body and implanted to “bypass” blocked coronary arteries.

Angioplasty uses a balloon to open the artery to allow blood to flow more freely.

Angioplasty carries fewer risks and may be more effective in selected cases than bypass surgery.

WEAPONS AGAINST CARDIOVASCULAR DISEASE

Can Aspirin Help Heart Disease?Low doses of aspirin (75 to 81 mg) daily or every

other day can be beneficial to heart patientsBlood-thinning propertiesRisks may outweigh the benefits

AN OVERVIEW OF CANCERSecond leading cause of death in the United States 1.5 million new cases diagnosed every yearEarly detection and improvements in technology

have improved prognosis for many.

Why do you think the rate of cancer is so high in the U.S. today?

AN OVERVIEW OF CANCER

What Is Cancer?Uncontrolled growth and spread of abnormal cellsNeoplasmsMalignant tumorsBenign tumors

METASTASIS

WHAT CAUSES CANCER?

Lifestyle RisksTobacco usePoor nutrition, physical inactivity, and obesityStress and psychosocial risks

Genetic and Physiological RisksGenetic predispositionOncogenes—cancer-causing gene that typically

stays dormant but can be activatedBiological sex Reproductive and hormonal risks

PROBABILITY OF DEVELOPING INVASIVE CANCERS

WHAT CAUSES CANCER?

Occupational and Environmental RisksExposure to asbestos, nickel, chromate, and

benzeneExposure to radioactive substancesChemicals in foodsMedical treatment risks

Infectious Diseases and CancerHepatitis B and hepatitis C Liver cancerHuman papillomavirus and cervical cancer

TYPES OF CANCER Categories of Cancer

CarcinomasSarcomasLymphomasLeukemias

Lung CancerCause of death of 159,390 Americans in 2009Symptoms include a persistent cough, blood-

streaked sputum, chest pain, and recurrent attacks of pneumonia or bronchitis

Hazards of secondhand smoke

LEADING SITES OF NEW CANCER CASES AND DEATHS,

2009 ESTIMATES

TYPES OF CANCER Breast Cancer

Approximately 192,370 women and 1,910 men were diagnosed in 2009

Risk increases with ageRisk factors supported by researchPrevention (self-exam and mammography)**Treatment

Surgical Selective estrogen-receptor modulators (SERMs)

BREAST AWARENESS AND SELF-EXAM

TYPES OF CANCER Colon and Rectal Cancer

Third most common cancer in men and women 146,970 cases were diagnosed in 2009 Warning signals include blood in the stool and rectal

bleeding. Skin Cancer

Affects over 1 million people every year Treatable: basal or squamous Virulent: malignant melanoma ABCD rule about melanoma

Asymmetry Border irregularity Color Diameter

TYPES OF SKIN CANCERS

TYPES OF CANCER Prostate Cancer

Most frequently diagnosed cancer in American males today, excluding skin cancer, and is the second leading cause of cancer deaths in men after lung cancer

192,280 new cases were diagnosed in 2009.Estimated 1 in 33 men will die from prostate cancer

in his lifetime Ovarian Cancer

Fifth leading cause of death in women21,550 new cases were diagnosed in 2009.Enlargement of the abdomen is a common warning

signPrevention: annual pelvic exams

TYPES OF CANCER Cervical and Endometrial (Uterine) Cancer

Regular Pap tests are crucial for early detectionRisk: early onset of intercourseWarning: abnormal bleeding

Testicular CancerAges 15 to 35 are at the greatest riskCause is unknownMen with undescended testicles appear to be at the

greatest risk

FACING CANCER Detecting Cancer

The earlier the cancer is diagnosed, the better prospect there is for survival

Practice self-exam and checkupsSeveral high-tech tools have been developed to

help detect cancer Magnetic Resonance Imaging (MRI) Computerized axial tomography scanning (CT scan)

SCREENING Breast Cancer

Women should know how their breasts normally look and feel and report any breast change promptly to their health care provider.

Colorectal CancerColonoscopy starting at age 50Stool sample testing

Cervical CancerAll women should begin cervical cancer

screening about 3 years after they begin having vaginal intercourse

Age 30 & Age 70

SCREENING Prostate Cancer

Age 45 & 50PSA test

Testicular CancerTSE

FACING CANCER Slash, burn, & poison Cancer Treatments

Surgery to remove tumorChemotherapyRadiotherapyResearching genes and cell mutations ImmunotherapyCancer-fighting vaccinesStem cell research

DIABETES Diabetes currently affects 23.6 million

Americans. Since 1980, incidence has increased over

50 percent among U.S adults. Diabetes is up by almost 70 percent

among those in their thirties. 7.8 percent of the population has some

form of diabetes. Approximately 225,000 people die each

year from diabetes-related complications. It is the sixth leading cause of death in

the United States today.

WHAT IS DIABETES? Diabetes Mellitus

Disease characterized by a persistently high level of sugar (glucose) in the blood

Pancreas fails to produce enough insulin or the body fails to use insulin effectively

Hyperglycemia—high blood glucose levels seen in diabetes

WHAT IS DIABETES? In Healthy People, Glucose Is Taken Up

Efficiently by Body CellsCarbohydrates from the foods are broken down

into a monosaccharide called glucose.

Liver and muscle cells store glucose as glycogen, then use it as needed to fuel metabolism, movement, and other activities

Pancreas—an organ located just beneath the stomach that secretes a hormone called insulin

Insulin—hormone secreted by the pancreas and required by body cells for the uptake and storage of glucose

WHAT IS DIABETES?

Types of Diabetes Type 1 diabetesType 2 diabetesGestational diabetes

WHAT IS DIABETES?

Pre-Diabetes Can Lead to Type 2 DiabetesA condition in which blood glucose levels

are higher than normal, but not high enough to be classified as diabetes

Affects more than 25 percent of the adult population

A ticking time bomb; if it’s not “defused,” diabetes will eventually strike

COMPLICATIONS OF UNCONTROLLED DIABETES

INCLUDE AMPUTATION AND EYE DISEASE

HOW IS DIABETES TREATED?

Diabetes Care Can Be ExpensiveOn average, health care costs for

diabetics are $15,000 to $25,000 higher per year than for healthy patients.

The direct and indirect costs of treating diabetes in the United States total $174 billion per year.

The costs related to undiagnosed diabetes are unknown.

ADVOCACY

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WHAT IS ADVOCACY?

The pursuit of influencing outcomes including: Public policy and resource allocation decisions within political, economic, and social systems and institutions that directly affect peoples lives

Major responsibility of health educators Tool for social/political change